Epidemiological Indicators Research Articles

A CDSS based Integrated Pathway for Influenza Vaccination Across Primary and Secondary Care

Abstract Background In Italy, influenza vaccination coverage in people ≥ 65 years is unsatisfactory (56.7%), underlining the need to improve current vaccination strategies. The objectives of this study have been: to define a novel pathway to increase influenza vaccination adherence among ≥ 65 years population in the Lazio region; to provide a predictive estimate of the epidemiological and economic pathway’s potential impact. Methods A multidisciplinary working group (WG) featuring cross-sectoral expertise was created and WG periodic meetings were held to define the patient journey and its flow-chart representation. The pathway’s potential impact was assessed through epidemiological and economic indicators and scenario analyses. Results An integrated pathway across primary and secondary care was defined, based on the active patient in-Hospital recruitment and vaccination and enhanced by a Clinical Decision Support System relying on a digital algorithm to identify eligible patients. Assuming an increase of influenza vaccination coverage from the current rate of 60% (scenario 1) to 65% (scenario 2) in ≥ 65 years population in the Lazio region thanks to the pathway implementation, an increase of 8% in avoided influenza cases, influenza- or pneumonia-related hospitalizations and influenza-related outpatient visits was estimated with a relative increase in savings for hospitalizations and outpatients visits of up 2,367,310 euros. Setting the vaccination coverage at 70% (scenario 3), an increase of 16% in avoided influenza cases, hospitalizations and outpatient visits was estimated with a relative increase in savings for hospitalizations and outpatients’ visits of up to 4,833,259 euros. Conclusions Alongside offering a predictive estimate of the relevant pathway’s potential impact, both epidemiological and economic, this project, with its robust methodology, may serve as a scalable and transferable model for enhancing vaccination coverage at national and international level. Key messages • The proposed pathway, offering the option of receiving flu vaccination within the Hospital, supports the paradigm shift towards primary prevention pathways in secondary care settings. • Another relevant aspect of the integrated pathway is the adoption of an Artificial Intelligence tool to identify suitable patients and improve their recruitment and adherence to vaccination.

Measuring functioning and disability in Korea: comparing general and dedicated surveys using the ICF

Abstract Background Functioning is the third health indicator besides mortality and morbidity. Although Korea periodically collects functioning information, the functioning indicator has not been generated yet. This study aimed to evaluate how functioning information is currently collected in Korea’s health and disability surveys, especially in terms of comparability and comprehensiveness, using the International Classification of Functioning, Disability and Health (ICF) as a reference framework. Methods Data sources included three health and disability surveys in Korea (Population and Housing Census, Korean National Health and Nutrition Examination Survey, Survey on the Living condition of Persons with Disabilities) and two international ICF-based surveys (International Spinal Cord Injury Survey, Model Disability Survey). Functioning information was linked by category to the ICF Generic-30 Set utilizing the ICF linking rules. Results Three ICF categories (walking, washing oneself, dressing) were covered by all the data sources. Excluding the Census, which inherently differs from the other data sources, all the surveys addressed six ICF categories-b152 emotional functions; b280 sensation of pain; d240 handling stress and other psychological demands; d450 walking; d510 washing oneself; d540 dressing. Despite of the common ICF categories, important differences in the operationalization of questions and response options were found. Conclusions The overlap of content of health and disability surveys in Korea enables interoperability with other data sources. Available functioning data can be used for estimating the functioning indicator and metric, as recommended by WHO, which can serve as a valuable epidemiological indicator for complementing mortality and morbidity indicators and for estimating and monitoring rehabilitation or long-term care needs of the Korean population. Key messages • Korea’s health and disability surveys periodically collect functioning information at the national level, and the level of overlap across surveys enables interoperability with other data sources. • This study can contribute to generate a Korean common health metric based on functioning that can serve as a valuable epidemiological indicator by utilizing the international standard ICF.

Public Health Challenges for 2050 in the Netherlands

Abstract Every 4 years, the National Institute for Public Health and the Environment (RIVM) carries out the Dutch Public Health Foresight Study, commissioned by the Ministry of Health. The ninth edition (PHFS-2024) compiles an outlook on future public health and the health care system in the Netherlands. It combines a business-as-usual Trend Scenario with literature study and a range of qualitative and mixed-methods approaches. The Trend Scenario comprises projections up to 2050 for a broad range of epidemiological indicators. Such as (healthy) life expectancy, disease burden, life style factors. The qualitative and mixed methods approaches supported an incremental intersubjective process. Methods were a focus groups study, stakeholder sessions and workshops. An important innovation in this study was the Citizen Council and Panel. The outcomes show that demographic development, in particular growth of the group people at high age with multimorbidity, will lead to high pressure on the formal and informal health care system but also on e.g. mental health. A life course approach applied shows that decreasing mental health of youth will have long term consequences. Also, overweight will deeply impact older people’s health in the future. Lastly, climate change in combination with e.g. energy transition will deeply affect our society and living environment. Next to these challenges, there will also be opportunities to improve health. Building a climate-proof living environment that also stimulates healthy life styles and social interaction is one of them. However, improving health has linkages with policy areas outside the traditional public health domain as well and requires, firstly, a Health in/for All Policies approach. Secondly a whole-of-society approach in which companies and civil organizations take action is needed. All these efforts can only be effective if people and communities are put at the core of all health policies.

Epidemiology of acute pulmonary embolism in children and adolescents from nationwide US hospital data, 2016 and 2019

Abstract Background Data on the epidemiological burden and comorbidities associated with pulmonary embolism (PE) in children and adolescents is sparse. Purpose We aimed to describe the burden of acute PE in children by estimating indicators of incidence and mortality as well as the prevalence of key comorbidities in hospitalized children with (vs. without) PE. Material and methods We did a patient-level analysis of the United States Kids' Inpatient Database (KID), including patients aged 0 to 19,cumulatively for the years 2016 and 2019. PE was defined by the ICD-10 Code I26. We calculated annualized, nationwide, age-sex-specific incidence rate, mortality rate, case mortality rate, and proportionate mortality rate. Additionally, we studied the prevalence of 120 clinically selected disorders in children with vs. without acute PE. Results Acute PE was recorded in 5,738 cases (58.6% female). A total of 244 (4.3%) patients were aged 0, 214 (3.7%) aged 1-4, 206 (3.6%) aged 5-9, 677 (11.8%) aged 10-14, and 4,392 (76.5%) aged 15-19 years. The incidence rate of PE shows a J-shape curve increasing with increasing age. Proportional mortality rate paralleled the incidence rate peaking at 9.5 (95% CI: 7.3-12.3) deaths per 1,000 deaths for girls and 5.0 (4.0-6.2) deaths per 1,000 deaths for boys aged 15-19 years. In contrast, case mortality rate decreased from 33% (95% CI: 24.8-42.4) among girls and 15.9% (95% CI: 10.8-23) among boys in the first year of age to 2.1% (95% CI: 1.6-2.7) among girls and 4.5% (95% CI: 3.6-5.6) among boys aged 15-19. Table 1 presents key age-sex stratified epidemiologic indicators. The highest absolute prevalence difference (APD) between those with vs. without PE was found for venous thrombosis (APD: 31.8%, 95% CI: 30.6-33), followed by metabolic disorders (APD: 15.2%, 95% CI: 14-16.5) and obesity (APD: 14.7%, 95% CI: 13.7-15.8). Figure 1 presents an overview of the APD of clinically selected disorders in patients with vs. without PE. Conclusion This comprehensive overview shows that the burden of PE among children and adolescents is considerable, but with considerable variation across age classes and co-occurrence with different specific comorbidities.Table 1.Figure 1.

Global trend of cervical cancer among women aged 55 and older from 2010 to 2019: An analysis by socio‐demographic index and geographic regions

AbstractObjectiveThis study describes the 2010–2019 trend of cervical cancer (CC) in women over 55 by socio‐demographic index (SDI) and geographical regions.MethodsWe obtained data on CC annually from 2010 to 2019 from the 2019 Global Burden of Disease Study (GBD) to analyze the incidence, death and prevalence rates, and disability‐adjusted life years (DALYs) associated with CC across different parameters such as global trend, age groups, SDI, continents, World Bank Regions, World Health Organization (WHO) regions, GBD regions, and National and territorial division. This analysis covers data from 204 countries and territories from 1990 to 2019.ResultsThere were 236,228 CC incidence cases worldwide in 2019, which is a 1.27‐fold increase from 2010. Global CC deaths also increased to 169,304 cases in 2019, reflecting a 1.24‐fold increase. CC prevalence increased to 769,925 cases in 2019, representing a 1.4‐fold rise. The number of CC DALYs globally increased to 3,835,979 cases in 2019, reflecting a 1.24‐fold increase. Incidence, death, prevalence, and DALY numbers of CC increased across all age groups females in the 65–69 years age group experienced the highest increase. Middle SDI countries had the highest incidence, death, prevalence, and DALY numbers, while low SDI countries showed increasing trends. Asia exhibited the highest incidence, death, prevalence, and DALY numbers of CC. Upper middle‐income countries had the highest incidence, death, prevalence, and DALY numbers, with the highest decreases in these rates except the prevalence rate. The Western Pacific Region showed the highest incidence, death, prevalence, and DALY numbers, with declining rate trends. The Republic of Kiribati showed the highest incidence, death, prevalence, and DALY numbers.ConclusionBased on the study results, it is clear that although the global trend of epidemiological indicators of CC is decreasing, the largest proportion of the decreasing trend is related to developing countries. But in regions of Africa and Asia that have a lower level of development, sometimes these indicators show upward trends, which shows the worsening of the problem in these regions and the need for serious policies and plans to implement comprehensive vaccination, screening, and promotion interventions. People's awareness is necessary in the field of better disease control.

Comparative assessment of the epidemic state of tuberculosis before and during the war in Ukraine

BACKGROUND. The war has a negative impact on patient care and the efficiency of the health care system; access to medical care is limited, coverage of preventive examinations and detection of tuberculosis (TB) are deteriorating. There is a threat of exacerbation of the epidemic situation with TB in Ukraine. OBJECTIVE. To assess the epidemic situation with TB during the war in Ukraine. MATERIALS AND METHODS. Comparison of data from the Ministry of health on TB (epidemiological indicators and indicators on detection, diagnosis and prevention) in the pre-war (2018-2021) and war (2022-2023) periods. RESULTS. The following were revealed: 1) a positive trend towards a decrease in epidemiological indicators of TB in 2018-2020, which slowed down in 2021 due to the COVID-19 pandemic, and a negative trend towards an increase in almost all indicators of TB incidence, separate indicators of mortality from TB and its prevalence in 2022-2023; 2) significant increase in the incidence of TB among contacts and children; 3) increase by ⅓-. of mortality from TB in certain regions; 4) correlation between regional rates of morbidity, mortality and prevalence of TB. In 2018-2023, the following decreased: fluorography examination, tuberculin diagnostics, detection of TB during preventive examinations (by 2-4 times), preventive vaccinations for children of the first year of life, detection of newly diagnosed and recurrent TB by smear, preventive treatment in contacts. CONCLUSIONS. Incidence is a marker of response to negative external factors and the main criterion for assessing the epidemic state of TB during the war. Fluorography examination, tuberculin diagnostics, detection of TB during professional examinations, preventive vaccinations for children of the first year of life, detection of newly diagnosed and recurrent TB by smear, preventive treatment of contacts are the main criteria for evaluating the activity of the anti-TB service during the wartime, since they are the first to significantly respond to the challenges of war.

Peculiarities of the dynamics of tuberculosis incidence in children in Ukraine

OBJECTIVE. To analyze the dynamics of the epidemiological situation with tuberculosis (TB) in children in Ukraine, taking into account the adverse effects of the coronavirus disease (COVID-19) pandemic and large-scale war. MATERIALS AND METHODS. The epidemiological and statistical indicators of TB incidence in Ukraine were analyzed. RESULTS. During 2022-2023, there was a negative trend in the incidence of TB – an increase in the incidence among all age groups. Among the children with TB, an accretion in the percentage of the most vulnerable contingents – children younger than 1 year old and adolescents (15-17 years old) – has been observed. Simultaneously there were a decrease in the number of children with small, limited forms of TB and an increase in the percentage of patients with bacterial excretion in all age groups. CONCLUSIONS. During the previous 2 years, for obvious reasons, the situation with TB detection, treatment and follow-up has deteriorated significantly. During the war, all children in Ukraine belong to the high-risk group for infection with Mycobacterium tuberculosis and TB disease and need (at the earliest opportunity) a specific screening examination for TB.

Epidemiological analysis of Road Accident Data Management System (RADMS) data in Tamil Nadu, India from 2011 to 2016: Future directions for an integrated national database

ABSTRACT Introduction: Globally, road traffic injuries (RTIs) are the eighth leading cause of death, with an estimated 1.35 million deaths yearly. In India, road traffic accidents (RTAs) are one of the major causes of mortality among the younger generation. We analyzed Tamil Nadu’s comprehensive Road Accident Data Management System (RADMS) data and described the epidemiological indicators of RTI in this setting. Methods: We obtained the data from the RADMS database for 2011–2016 and used 2011 population census data to project and standardize for different age groups and genders to calculate incidence. We calculated average annual percentage changes (AAPC) with a 95% confidence interval for the whole period. We computed Joinpoint regression analysis for trends and calculated the age-adjusted incidence rate with standard error (SE) using R statistical computing software. Results: We included 3,67,094 RTAs and 5,50,447 RTIs. We observed that the incidence of RTAs and RTIs declined between 2011 and 2016. Most injured were males (82%) and aged 20–39 years (49%). The highest number of accidents occurred on the state highways (65.2%) and on Sundays (17%). Age-adjusted incidence (per 1,00,000) declined from 121.87 (SE 0.4) in 2011 to 92.73 (SE 0.34) in 2016 (AAPC = -4.5% (95% CI = -7.8 to -1)). The age groups 30–39 and 20–29 were 9.82 (z = 8.98; P < 0.05) and 9.02 (z = 8.65; P < 0.05) times at a higher risk compared to 0–9 years old. The motorcyclists (14–27 times; P < 0.05) and pedestrians (12–23 times; P < 0.05) had the maximum risk of RTIs. Conclusion: Young adults, drivers, motorcyclists, and pedestrians remain vulnerable populations for RTIs. More accidents occurred in the state highways and on Sundays. The analysis provides insights on RTIs and RTAs, which will be used to reduce the burden of RTIs and save millions of lives.

Gestantes vivendo com HIV e crianças expostas ao HIV em Santa Catarina, dados epidemiológicos de 2015 a 2021

Vertical transmission is the transmission of an infection or disease from the mother to her fetus in the womb or newborn during childbirth. The main routes of contagion are pregnancy, childbirth and breastfeeding. To prevent transmission, all pregnant women should be investigated and monitored during the gestational period, at the time of delivery and in the puerperium. The follow-up of pregnant women in prenatal care includes the performance of several laboratory tests to identify the presence of infectious agents of vertical transmission, such as the Human Immunodeficiency Virus (HIV), guiding the treatment of the pregnant woman and avoiding infection of the fetus, also providing guidance on the possibilities of prevention. Considering the high number of HIV cases in the state of Santa Catarina, especially in the Alto Vale Itajaí region, the present study aims to present the epidemiological profile of HIV/AIDS indicators of the population of the state of Santa Catarina, specifically pregnant women and children exposed to HIV, in the period from 2015 to 2021. It is an epidemiological, retrospective, descriptive and analytical study of a historical series, also presenting information on the factors involved in vertical transmission of HIV and prevention strategies. The parameters evaluated in this study, collected from the Epidemiological Indicators Panel of the Department of Chronic Conditions Diseases and Sexually Transmitted Infections, were: number of children exposed to HIV, age of children exposed to HIV, number of HIV-infected pregnant women (GVHIV) and monitoring of these in relation to HIV viral load (CV) and CD4+ T lymphocyte count (CD4+) at the beginning of antiretroviral therapy. Although the systematization of the number of pregnant women with HIV and children exposed to the virus in the state of Santa Catarina shows annual differences in the period evaluated, the trend line referring to the number of GVHIV shows a small increase over the years, while the trend line for the number of children exposed to the virus reveals a slight decrease, which can be elucidated by the expansion of the health team and the improvement in surveillance in the prevention of vertical transmission of HIV that has occurred over the years. The percentage of pregnant women with HIV VC lower than 50 copies/mL showed a gradual increase in the years evaluated, while the percentage with VC greater than 50 copies/mL showed a decrease. During the period evaluated in this study, less than 50% of the GVHIV had a CD4+ count and, among these, approximately 20% had CD4+ less than 350 cells/mm³ at the beginning of antiretroviral therapy. Failure to perform CD4+ counts may be related to an increase in the number of pregnant women with a VC of less than 50 copies/mL. Thus, CD4+ counts would be performed primarily in pregnant women with VC greater than 50 copies/mL and part of them with greater depletion of this cell type. In summary, this study shows the evolution of the treatment and follow-up offered to GVHIV and, consequently, to their children. It also reinforces the importance of prevention, diagnosis, treatment and prenatal follow-up strategies.

Outbreak reconstruction with a slowly evolving multi-host pathogen: A comparative study of three existing methods on Mycobacterium bovis outbreaks

In a multi-host system, understanding host-species contribution to transmission is key to appropriately targeting control and preventive measures. Outbreak reconstruction methods aiming to identify who-infected-whom by combining epidemiological and genetic data could contribute to achieving this goal. However, the majority of these methods remain untested on realistic simulated multi-host data. Mycobacterium bovis is a slowly evolving multi-host pathogen and previous studies on outbreaks involving both cattle and wildlife have identified observation biases. Indeed, contrary to cattle, sampling wildlife is difficult. The aim of our study was to evaluate and compare the performances of three existing outbreak reconstruction methods (seqTrack, outbreaker2 and TransPhylo) on M. bovis multi-host data simulated with and without biases. Extending an existing transmission model, we simulated 30 bTB outbreaks involving cattle, badgers and wild boars and defined six sampling schemes mimicking observation biases. We estimated general and specific to multi-host systems epidemiological indicators. We tested four alternative transmission scenarios changing the mutation rate or the composition of the epidemiological system. The reconstruction of who-infected-whom was sensitive to the mutation rate and seqTrack reconstructed prolific super-spreaders. TransPhylo and outbreaker2 poorly estimated the contribution of each host-species and could not reconstruct the presence of a dead-end epidemiological host. However, the host-species of cattle (but not badger) index cases was correctly reconstructed by seqTrack and outbreaker2. These two specific indicators improved when considering an observation bias. We found an overall poor performance for the three methods on simulated biased and unbiased bTB data. This seemed partly attributable to the low evolutionary rate characteristic of M. bovis leading to insufficient genetic information, but also to the complexity of the simulated multi-host system. This study highlights the importance of an integrated approach and the need to develop new outbreak reconstruction methods adapted to complex epidemiological systems and tested on realistic multi-host data.

Multifractal properties of Covid-19 data

Multifractal detrended moving average analysis (MFDFA) has been performed on time series of three different epidemiological indices, namely daily number of new cases per million population, reproduction rate and positive rate, recorded during the Covid-19 pandemic. We consider India, Japan, USA and UK for this study. For all the series the scaling behavior of MFDMA fluctuation functions has been examined, and the multifractal variables like the generalised Hurst exponent spectra and singularity spectra have been calculated. It is found that the time series of the Covid-19 indices are of multifractal nature. The degree of multifractality of the reproduction rate series is significantly weaker than the other two series for all the countries. To find out the source(s) of multifractality, we generate a set of one hundred shuffled series and Amplitude-Adjusted Fourier Transform surrogate series for each of the original series. Comparing the results obtained from the original series with those from the shuffled and surrogate series we understand that the main source of multifractality in Covid-19 data is long-range temporal correlation among the series values.

Impact of recent criteria changes for the deferral criteria specific to men who have sex with men in France.

In 2016, France allowed men who have sex with men (MSM) to donate blood if they had not had sex with men in the previous 12 months. In April 2020, this restriction was relaxed to 4 months due to the lack of negative impact observed on blood safety. This study assesses the impact of reducing this deferral period on epidemiological surveillance indicators. This study compares infection surveillance indicators between two 30-month periods before (P1) and after (P2) this second deferral change. Overall, 79 donations tested positive for human immunodeficiency virus (HIV) (49 in P1 and 30 in P2), 322 for hepatitis C virus (HCV) (185 and 137), 622 for hepatitis B virus (HBV) (355 and 267) and 1684 for syphilis (799 and 885). Positive donation rates decreased between P1 and P2, except for syphilis: HIV (0.07/10,000 donations vs. 0.04; p > 0.5), HCV (0.25 vs. 0.20; p < 0.05), HBV (0.49 vs. 0.39; p < 0.01) and syphilis (1.10 vs. 1.29; p < 0.001). For all three viruses, residual risks of transmission by transfusion did not increase: HIV (1/7,800,000 donations vs. 1/10,500,000), HCV (1/25,200,000 vs. 1/47,300,000) and HBV (1/6,400,000 vs. 1/6,000,000). Reducing the deferral period for MSM in April 2020 did not negatively impact residual risks, which remained very low, or the rate of positive donations, except for syphilis, which requires careful monitoring. To ensure equal access to blood donation, MSM have been allowed to donate blood under the same conditions as other donors since March 2022 (i.e., no more than one sexual partner in the last 4 months).

БРОНХИАЛЬНАЯ АСТМА У ДЕТЕЙ ГРОДНЕНСКОЙ ОБЛАСТИ. РАСПРОСТРАНЕННОСЬ, ЗАБОЛЕВАЕМОСТЬ, МНОГОЛЕТНИЕ ЭПИДЕМИОЛОГИЧЕСКИЕ ТРЕНДЫ ДИНАМИКИ

Background. Bronchial asthma is the most widespread chronic nonspecific lung disease in children. Monitoring the prevalence of asthma is an important part of a set of measures aimed at preventing and effectively treating the disease. Purpose of the study. To study the long-term dynamics of the main epidemiological indicators of the overall and primary incidence of asthma in the child population of the Grodno region. Material and methods. We performed a retrospective analysis of the indicators of the overall and primary incidence of bronchial asthma in children of the Grodno region. The study period was 1999-2023 years for children aged 0-14 years and 2008-2023 years for children of 15-17 years old. Results. The long-term average standardized indicator of the overall incidence of bronchial asthma in children aged 0-14 years (1999-2023) was 597.13 (95% CI: 562.88-631.37), that of primary incidence – 79.94 (95% CI: 67.52-92.37) per 100,000 children of the corresponding age. The long-term average incidence of bronchial asthma in children aged 15-17 years (2008-2023) was 1157.69 (95% CI: 1070.69-1244.71), that of primary incidence – 44.29 (95% CI: 33.52-55.05) per 100,000 children of this age. In the age group of 0-14 years, the overall incidence of bronchial asthma was dominated by children aged 10-14 years, the primary incidence – by children of 5-9 years old. The long-term epidemic dynamics were characterized by a moderately pronounced tendency towards an increase in the standardized indicator of the overall incidence in children aged 0-14 years (average growth rate =+1.32%) and those aged 15-17 years (average growth rate =+2.87%), stabilization of the indicator of primary morbidity in children of 0-14 years old (average rate of decline = -0.49%) and a downward trend in the rate of primary morbidity (average rate of decline = -3.48%) in children aged 15-17 years. The levels and average long-term trends in the dynamics of indicators in individual territorial and administrative districts of the region have been established. The trends in the dynamics of asthma incidence rates in the administrative territories of the region during the analyzed period were multidirectional and had varying degrees of stability. The cartograms of the territorial distribution of bronchial asthma incidence rates in children of the Grodno region in the periods 1999-2023 (0-14 years) and 2008-2023 (15-17 years) are presented. Conclusions. The reasons for the established patterns in changes in the incidence of bronchial asthma in children of different age groups and those living in different territories require further study.

Mortality attributable to diabetes in Cuba: Estimates for 2019

ObjectiveTo estimate the national and provincial number of excess deaths due to diabetes across Cuba in 2019. Study designCross-sectional design with secondary data. MethodsWe used DISMODII, a computerized generic disease model, to assess disease burden by modelling the relationships between incidence, prevalence, and disease-specific mortality. Baseline input data included population structure, total mortality, and age- and sex-specific estimates for diabetes prevalence from the Cuban National Health Survey 2019, and available published estimates of the relative risk of death for people with diabetes compared to people without diabetes. The results were internally validated with DISMODII output for duration of diabetes (years). ResultsIn 2019, we estimated an excess of mortality attributable to diabetes of 7.5 times the diabetes mortality reported by the National Death Registry, which is equivalent to 16.4 % of all deaths in Cuba. The percentages of all-cause mortality among provinces varied between 10.7 % in Villa Clara and 24.5 % in Ciego de Avila. ConclusionsThese are the first estimates of mortality attributable to diabetes in Cuba and its provinces. Diabetes is likely to be a much more prominent leading cause of death than the 9th ranking reported by the Cuban National Death Registry 2019. Disease models similar to DISMODII are important tools to validate the epidemiologic indicators used in the burden of disease calculations.

Long-term dynamics of epidemiological characteristics of some chronic leukemia and lymphoma in Moscow before, during and after the pandemic of the new coronavirus infection COVID-19. Epidemiologic study

Background. The COVID-19 pandemic, which swept the world in 2020–2021, had a significant impact on the epidemiological picture of hematological malignancies. Aim. To study the dynamics of epidemiological indicators of five chronic hemoblastoses in Moscow over a 12-year period, and also to assess the impact of the COVID-19 pandemic on these indicators. Materials and methods. A population-based study was conducted for five types of oncohematological diseases: multiple myeloma, Hodgkin's lymphoma, follicular lymphoma, chronic lymphocytic leukemia, chronic myeloid leukemia. The annual rates of morbidity, mortality, prevalence of these nosologies, overall survival, and expected overall survival were calculated. Gender and age characteristics for each disease were determined. Results and discussion. The present study showed a uniform increase in the incidence and prevalence of five hematological malignancies between 2012 and 2019. Convincing evidence of an increase in mortality and a decrease in the number of diagnosed cases in comparison with the expected figures for these hematological malignancies in 2020–2021 was presented. A greater reduction was shown for cases diagnosed at early stages compared to later ones. During the pandemic, a significant increase in mortality was recorded among patients with chronic lymphocytic leukemia and multiple myeloma, while in cohorts of patients with chronic myeloid leukemia and Hodgkin lymphoma it increased slightly. The return of morbidity, mortality and prevalence rates to the original dynamics in 2022–2023 has been demonstrated. Conclusion. This study demonstrated the features of the regional pattern of incidence, mortality, prevalence and gender-age characteristics of five hematological malignancies and provided the changes in the indicators dynamics of different hematological malignancies during the COVID-19 pandemic.

Perfil metabólico, zootécnico e sanitário de bezerras Girolando concebidas por fertilização in vitro

ABSTRACT: This study determined the zootechnical, metabolic, and health performance of Girolando calves born with high or low birth weight, conceived through in vitro fertilization. The study was carried out on a commercial dairy farm located in Passos, Minas Gerais, Brazil. For this, a hundred Girolando calves were divided into two groups: The Control, which consisted of calves that were born weighing ≤ 35 kg; and high birth weight (HBW) calves, which were born weighing &gt; 35 kg. The calves were monitored for zootechnical parameters; epidemiological indices, for diseases such diarrhea and pneumonia; as well as serum concentrations of aspartate aminotransferase, alanine aminotransferase, alkaline phosphatase, gamma-glutamyl transferase, cholesterol, triglycerides, paraoxonase1, albumin, urea, and globulin. Calves from the HBW group had a higher general mortality rate, but no effects on the zootechnical performance or metabolism were observed. The results obtained allow us to conclude that Girolando calves generated by IVF and heavier at birth have a greater chance to present diseases such as omphalophlebitis, tympany, and bovine parasitic sadness, and have a higher rate of general mortality. Conversely, birth weight of the calves does not influence diarrhea or pneumonia, the zootechnical performance, or the metabolism.

Trends in incidence of infrequent and frequent synchronous metastases from colorectal cancer

BackgroundPopulation-based data on the incidence of frequent colorectal metastases are fairly scarce, while that on rare metastatic sites are lacking. AimsThe aim of this study was to provide epidemiological indicators of metastatic sites frequency in patients with colorectal cancer. MethodsIncidence was modelled using Poisson and Joinpoint regressions in a population-based cancer registry study including metastatic colorectal cancers diagnosed between 1991 and 2020 (N = 5,199). Tumor molecular markers were collected for the [2016–2020] period. ResultsLiver, peritoneum, lung and bone were the most frequent metastatic sites. Among frequent sites, incidence of liver and lung sites decreased in men respectively since 1999 and 2010, whereas in women incidence of liver and peritoneum sites increased steadily throughout the whole period. Each of the other sites concerned less than 3% of metastatic colorectal cancer cases and presented standardized incidence rates between 0.19 and 1.39 per 1,000,000. Among rare sites, incidence of adrenal glands, supraclavicular lymph node, mediastinum and ascites had doubled in [2016–2020] as compared to the 25 previous years. BRAFV600E variant was more frequent in presence of carcinomatosis, and absence of liver and lung metastasis while KRAS variant was more frequent in presence of lung metastasis. ConclusionThis study provides unprecedented incidence indicators for rare synchronous metastases of colorectal cancer.

The Impact of Socio-Economic Conditions on Individuals’ Health: Development of an Index and Examination of its Association with Three of the Most Frequently Registered Diseases in Lazio Region of Italy

This study examines spatial disparities and associations between the social deprivation index (SDI) and Type 2 Diabetes, Dementia, and Heart Failure in Italy’s Lazio Region. The primary goal is to assess how social deprivation impacts health inequalities by analysing SDI-disease correlations. This retrospective study uses 2020 socioeconomic data and 2021 epidemiological indicators in Lazio Region, Italy. The SDI, constructed following established guidelines, measures social deprivation. Statistical tools, including regression models, Moran’s I test, and LISA techniques, are used to analyse spatial patterns. Utilizing a retrospective approach, we merge 2020 socioeconomic and 2021 epidemiological data for analysis. The SDI is computed using established methods. Spatial disparities are explored through regression models, Moran’s I test, and LISA techniques. The study reveals significant disparities in disease incidence. District V in Rome exhibits high Type 2 Diabetes (113.75/1000) and Heart Failure (37.98/1000) rates, while Marcetelli has elevated Dementia incidence (19.74). Southern municipalities face high unemployment (up to 25%), whereas bordering areas have higher education levels (30–60%). Disease hotspots emerge in Rome and centre-north municipalities, aligning with social deprivation patterns. Regression models confirm the link between disease incidence and socioeconomic indicators. SDI ranges from − 1.31 to + 10.01. This study underscores a correlation between social deprivation and disease incidence. Further national-level research is essential to deepen our understanding of how social deprivation influences health outcomes, with potential implications for addressing health disparities both regionally and nationally.

Dementia care landscape in Nepal: Understanding the context, barriers, and opportunities for the development of a national dementia care plan.

This study was conducted to comprehensively understand the context, barriers, and opportunities for improving dementia care, treatment, and support. The objective is to guide the development of a national dementia care plan. This document review was conducted by analyzing literature available in the public domain, including scientific publications, project documents/reports, media reports, and hospital records. Additionally, annual reports published by the Department of Health Services, national census and demographic and health survey reports, Old Age Homes, and other relevant government reports were examined. Firsthand information was gathered from relevant stakeholders based on the World Health Organization's situational analysis framework for dementia plans. This framework encompasses four domains: Policy context (national ministries, legislation, policies, strategies, plans related to dementia, mental health, aging, and disability), service delivery assessment (health and social care workforces, services, support and treatment programmes, and promotion of awareness and understanding), and epidemiological indicators (prevalence and incidence rates of dementia, risk factors). Ethical clearance was obtained from the Institutional Review Committee (IRC) of B.P. Koirala Institute of Health Sciences (IRC no.2658/023). Existing policies in Nepal inadequately address the needs of people with dementia and their caregivers. Concerning health services, the Government of Nepal provides financial subsidies to individuals diagnosed with dementia; however, numerous hurdles impede access to care. These obstacles include geographical and structural barriers, an inefficient public healthcare system, weak governance, financial constraints, low awareness levels, stigma, and inadequate workforce. Furthermore, the absence of robust nationally representative epidemiological studies on dementia in Nepal hampers the development of evidence-based plans and policies. Similarly, there are no interventions targeted at caregivers of people with dementia, and no initiatives for dementia prevention are in place. This review underscores the urgent need to formulate a comprehensive national dementia care plan to address the growing challenges. Key priority action areas include the integration of dementia care into primary healthcare services, training workforce to provide the care, increasing awareness, mitigating stigma, developing caregiver support programs, and initiating high-quality research to inform evidence-based policymaking.

Why motivation for adhering to COVID-19 measures matters: Investigating time-lagged associations with epidemiological indicators.

Why motivation for adhering to COVID-19 measures matters: Investigating time-lagged associations with epidemiological indicators.